Mapping of Vertical Femoral Neck Fractures in Young Patients Using Advanced 2 and 3-Dimensional Computed Tomography

Sarfani, Shumaila; Beltran, Michael J.; Benvenuti, Michael A.; Collinge, Cory

doi:10.1097/bot.0000000000002102

Cited by 11 publications

(17 citation statements)

References 38 publications

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“…The 3D maps of the fracture lines and bone defects were presented separately to support a better understanding of the fracture morphologies. 3D mapping techniques have previously been used to study the morphological characteristics of fractures (including fractures of the patella, tibial plateau, distal femur, and scapula), suggest new surgical approaches, and develop fixation innovations to better address complex injuries ( 9 , 16 ). However, while 3D fracture mapping techniques are recognized and well accepted, previous studies have not examined the reliability of this evaluation method.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, malreduction and fixation instability may prevent normal fracture healing ( 7 , 8 ). Thus, insights into the morphological characteristics of fracture lines and bone defects will improve the understanding of DFNFs, which may aid in enhancing preoperative planning, intraoperative surgical techniques, and mechanical study models ( 9 ). At present, age is established as an important factor in clinical decision-making for patients with DFNFs; however, the relationships of age and other parameters with morphological features of DFNFs have yet to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Wu¹,

Zhu²,

Wei³

et al. 2022

Ann Transl Med

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Background: This study aimed to define the distribution and frequency of fracture lines and bone defects in displaced femoral neck fractures (DFNFs) using a three-dimensional (3D) mapping technique, and to investigate the factors associated with the area of bone defects in patients with DFNFs. Methods:The data of 256 adult patients with DFNFs were retrospectively reviewed. Multiplanar reconstructions of the DFNFs were made using computed tomography (CT) images, and the DFNF fragments were virtually reduced to match a 3D model of the femoral neck. Subsequently, 3D mapping was performed by graphically superimposing all of the fracture lines and bone defects onto a femoral neck template. The 3D mappings were independently examined by two orthopedic surgeons, and the interobserver agreement was analyzed. For intraobserver analysis, one of the surgeons measured the mappings twice more, and the intraclass correlation coefficients (ICCs) were calculated. A linear regression analysis was conducted to explore bone defect area-related factors. Results:The cohort comprised 141 (55%) patients with left hip injuries and 115 (45%) patients with right hip injuries. On the 3D maps, the dense zones of the fracture lines were largely observed from the superior to the posterior part of the femoral neck, while the dense zone of the bone defect was primarily concentrated in the posterior part of the femoral neck. Only a few dense zones were located in the anterior and inferior parts of the femoral neck. An overlapping region between the fracture line and the bone defect was located in the 2.5th to 4.5th (5th) part of the 1/10 of the superior (posterior) femoral neck length. Both the fracture line and bone defect mapping techniques had good intra-and inter-observer reliability, with ICCs of 0.879 (0.977) and 0.780 (0.974), respectively. Garden type and age were positively correlated with bone defects, while simplified AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification was negatively associated with bone defects. Conclusions:The fracture lines and bone defects of the DFNFs were mainly located in the superior and posterior parts of the femoral neck, while an overlapping region was observed in the subcapital area of the femoral neck. 3D mapping is a reliable method for searching for DFNF features, and separately studying fracture lines and bone defects can further elucidate the morphology of these fractures. Bone defects in patients with DFNFs were associated with Garden type, simplified AO/OTA classification, and age.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Wu¹,

Zhu²,

Wei³

et al. 2022

Ann Transl Med

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“…However, the above-mentioned factors are essential for making a preoperative plan and achieving an excellent clinical outcome [ 11 ]. The fracture mapping technique created by Armitage et al based on three-dimensional (3D) CT has been widely utilized to elucidate the patterns of fracture lines, especially in irregular bone and intra-articular fractures [ 12 – 14 ]. With increasing concern over precise treatment and the application of various medical image postprocessing software, fracture mapping has been increasingly more common in orthopedic fields.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional mapping study of pure transverse acetabular fractures

Zhai

Yin

et al. 2022

J Orthop Surg Res

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Background To describe and analyze the morphological characteristics, location and frequency of pure transverse acetabular fracture lines through fracture mapping and quantitative measurements. Methods Transverse fractures were retrospectively reviewed and analyzed. All computed tomography (CT) data were used for reconstruction and manual reduction. The reductive fracture fragments were graphically overlaid onto a three-dimensional (3D) right hemipelvis template. Then, the fracture lines were accurately depicted onto the surface of the 3D template. The fracture lines were overlapped onto the model to create the 3D fracture map and heatmap. All cases were subdivided into infratectal (62-B1.1), juxtatectal (62-B1.2), and transtectal (62-B1.3) types based on the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification. Some anatomic parameters of the transverse fractures were also analyzed in these 3 groups. Results Our study included forty-nine transverse fractures from 32 male and 17 female patients (mean age, 42 years; range 21–74 years) and included 19 type 62-B1.1, 17 type 62-B1.2, and 13 type 62-B1.3 fractures. The average anterior rim fracture angle was 70.0° (± 11.6°), and the posterior rim fracture angle was 92.4° (± 28.5°). The anterior rim fracture angles in 40 cases (40/49, 81.6%) fell within a wide range between 63° and 80°. On the heatmap, the hot zones were located on the highest position of the cotyloid fossa and the narrowed region, and the cold zone was on the inferior third of the articular surface. For type 62-B1.3 fractures, the hot zone was located on the posterior of the acetabular dome. There were no significant differences in anterior rim fracture angle and anterior height among the three patterns (P = 0.071, P = 0.072). Post hoc tests of the posterior rim fracture angle and the posterior height revealed significant differences among fracture subtypes (P < 0.01). The posterior intra-articular fracture line was significantly longer than the anterior intra-articular fracture line in type 62-B1.1 and type 62-B1.2 fractures (P < 0.01). Conclusion The fracture lines of transverse fractures through the anterior rim were concentrated on the narrowed zone, and the posterior fracture lines were diffusely distributed. The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. The recurrent fracture lines involving the weight-bearing dome mainly converged on the posterior region of the roof.

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“…Vertically oriented fractures are highly unstable and require support to decrease varus and early failure. 2,4 The Smith–Petersen approach is safe for use in femoral neck fractures and allows adequate exposure to reduce the femoral neck under direct vision and may be used more commonly in younger patients. 5 5.…”

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confidence: 99%

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Collinge

2023

Journal of Orthopaedic Trauma

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young patients is humbling and we must continue to diligently search for and test modifiable factors to improve outcomes. In our opinion, the debate about whether all displaced femoral neck fractures in the young should receive an open or closed approach does not serve the best interest of our patients. Every surgeon who treats these complex injuries should be adept at both open approaches and closed reduction techniques-and be able to implement each to provide their patients with a quality reduction. Until a threshold value is more rigorously validated, we agree with Collinge et al that no more than 2 mm of displacement or 5 degrees of angulation observed in any plane should be the goal of reduction, whether obtained by open or closed means.

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Mapping of Vertical Femoral Neck Fractures in Young Patients Using Advanced 2 and 3-Dimensional Computed Tomography

Cited by 11 publications

References 38 publications

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Three-dimensional computed tomography mapping and clinical predictive factors for morphologic characterization of displaced femoral neck fractures

Three-dimensional mapping study of pure transverse acetabular fractures

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